Strengthening SME system for Lao PDR National Malaria Programme (2016-2020) By Dr. Bouasy, Dr. Viengxay and Dr. Odai CMPE, Lao PDR With support from Dr.

Strengthening SME system for Lao PDR National Malaria Programme

(2016-2020)

ByDr. Bouasy, Dr. Viengxay and Dr. Odai

CMPE, Lao PDRWith support from

Dr. Seshu Babu, WHO, Lao PDR

Outline of Presentation NSP Goals, Objectives, Roadmap and Timelines Provinces selected for Surveillance Planning Exercise Review of current SME system: SWOT Analysis, Strengthening of relevant SME areas Plan to strengthen the existing system for malaria elimination PCD & ACD proposed in Lao PDR and Data flow Responsibilities for recording and transmission Case investigation for elimination, Classification and Types of Foci Assessment of human resources needs Revised essential job descriptions for surveillance workers Proposed Indicators Electronic (IT) based data management Field monitoring and Supportive Supervision, Improving the organization of

supervision Communication of results, Evaluation of SME System performance Reporting National Independent Malaria Elimination Monitoring Committee Updating legislation Involvement of private sector

NSP Goals Phase 1 (2016-2020):The overall goal of the phase 1 of NSPMCE is to flatten the malaria epidemic and reduce the impact of multi-drug resistance in the southern part and move progressively towards malaria elimination in the northern and central part of the country while aligning with the GMS regional elimination efforts. Phase 2 (2021-2025):The phase 2 goal of the NSPMCE is to eliminate Plasmodium falciparum malaria in the entire country along with the entire GMS region and to eliminate all species of malaria in the northern/central provinces. Phase 3 (2026-2030):The phase 3 goal of the NSPMCE is to eliminate all forms of malaria by 2030 in the entire country.

NSP ObjectivesPhase 1 Phase 2 Phase 3

1. Reduce the incidence of Plasmodium falciparum to less than 5 per 1,000 in the southern Laos by 2020

2. Interrupt the transmission of Plasmodium falciparum in the northern and central Laos by 2018.3. Reduce the incidence of indigenous cases of Plasmodium vivax to <1 per 1,000 in the northern and central Laos by 2020.4. Prevent reintroduction of malaria transmission in areas where it has been interrupted.

1. Interrupt the transmission of Plasmodium falciparum in the entire country by 2025.

2. Interrupt the transmission of Plasmodium vivax in the northern and central Laos by 2025.3. Prevent reintroduction of malaria transmission in areas where it has been interrupted.

1. Interrupt the transmission of all forms of malaria in the entire country by 2030.

2. Prevent reintroduction of malaria transmission in areas where it has been interrupted.

3. Apply for certification of malaria free status by 2030.

Roadmap to malaria elimination in Laos

PROPOSED TIMELINES FOR MALARIA ELIMINATION IN LAO PDR

(2016-2030)

2017 2020 2025 2030

• 2018: Elimination of Pf in all northern/central provinces except Phongsaly and reduction of API to <10/1,000 in the southern provinces • 2020: Elimination of Pf in all northern/central provinces and reduction of API to <5/1,000 in the southern provinces • 2025: Elimination of Pf from entire country including southern provinces and elimination of Pv in northern/central provinces • 2030: Elimination of Pv from the entire country

CHINA

MYANMAR

THAILAND

VIETNAM

THAILAND

CAMBODIA

VIETNAM

PROVINCES SELECTED FOR SURVEILLANCE EXERCISE

Towards elimination by 2020

Towards pre-elimination by 2020

Province/country/state/region 2014 2015(6 Mth) 2016 2017 2018 2019 2020 CommentName: Saravanh province

Population 414539 424902 435525 446413 457573 469013 480738Based on population projections

with 2.5 % annual pop growth

% of PAR 90% 90% 85% 80% 75% 75% 75%

Population at risk expected to decreased owing to reducing forest cover along with increasing urbanisation limiting areas of transmission coupled with rapid response to foci

PAR 373085 382412 370196 357131 343180 351760 360554

Expected reduction in API 15% 20% 25% 30% 40%

Initially API epected to be increased due to increased coverage of reporting followed by reduction in cases due to interventions

3 prioityies for period 2015 - 20 reported API (local) /1000 PAR 29.12 15.46 13.14 10.51 7.88 5.52 3.31

#local cases reported 12070 5912 4865 3754 2706 1941 1194This province is characterised by high transmission levels

% of cases reported 75% 75% 85% 95% 95% 95% 100%

Currently a number of cases don’t seek treatment due to long stays in the forest, self-treatment and seeking care from private faciities that do not report to HMIS

# surveillance staff (person-year of malaria work) (8 districts + 1 PAMS) 10 10 18 18 18 18 18

projected numbers are based on the need to achieve the desired surveilance coverage and reduction in # of cases

Phases(Con/Elim/Prev) control control control control control control Pre- EliminationThe province will be targeted to enter pre-elimination phase by 2020

we selected four province to be representative of 18 provinces in different phases of malaria control - Elimination continuum ( 2 currently in control, 2 in pre-elimination)

Name: Champasack provincePopulation 771510 790798 810568 830832 851603 872893 894715

Based on population projections with 2.5 % annual pop growth

% of PAR 90% 90% 85% 80% 75% 75% 75%


PAR 694359 711718 688983 664666 638702 654670 671037

Expected reduction in API 15% 20% 25% 30% 40%

Initially API epected to be increased due to increased coverage of reporting followed by reduction in cases due to interventions

3 prioityies for period 2015 - 20 reported API (local) /1000 PAR 32.37 23.85 20.27 16.22 12.16 8.51 5.11

#local cases reported 24970 9431 13967 10780 7769 5574 3428This province is characterised by high transmission levels



# surveillance staff (person-year of malaria work) ( 10 districts + 1 PAMS) 11 11 22 22 22 22 22


Phases(Con/Elim/Prev) Control Control Control Control Control Control Pre- EliminationThe province will be targeted to enter pre-elimination phase by 2020

Name: Khammouane provincePopulation 430464 441226 452256 463562 475151 487030 499206


% of PAR 80% 80% 75% 70% 65% 60% 60%


PAR 344371 352981 339192 324494 308848 292218 2995243 prioityies for period 2015 - 20 reported API (local) /1000 PAR 0.67 0.61 0.55 0.50 0.40 0.30 0.20

#local cases reported 288 134 187 162 124 88 60This province is characterised by very low transmission levels



# surveillance staff (person-year of malaria work) (10 districts + 1 PAMS) 11 11 11 11 11 11 11


Phases(Con/Elim/Prev) Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination EliminationThe province will be targeted to enter elimination phase by 2020

Name: Hauphan provincePopulation 358721 367689 376881 386303 395961 405860 416006


% of PAR 80% 80% 75% 70% 65% 60% 60%

Although there is no apparent local transmission, there is a lot of population movement in and out of the province indicating that there would still be some malaria cases seeking treatment from health facilities.

PAR 286977 294151 282661 270412 257374 243516 2496043 prioityies for period 2015 - 20 reported API (local) /1000 PAR 0.02 0.02 0.02 0.02 0.02 0.02 0.01

#local cases reported 7 4 6 5 5 5 2

This province is characterised by no known transmission (will be verified shortly)


Currently the cases are presumed to be all imported from other parts of the country.

# surveillance staff (person-year of malaria work) 10 10 10 10 10 10 10

projected numbers are based on the need to maintain the desired surveilance coverage.

Phases(Con/Elim/Prev) Pre - Elimination Pre - Elimination Pre - Elimination Pre - Elimination Elimination Elimination EliminationThe province will be targeted to enter elimination phase by 2018

Review of current SME system: SWOT AnalysisStrengths• Strategic reforms in the health sector including HMIS

using the DHIS2 platform• Strong policy commitments to data use for decision

making • Good progress in Government efforts towards

attaining MDG targets• Clear and robust second Health Strategic Plan with an

M&E component• Increasing support for SME from major funding

agencies• Highly experienced and committed Epidemiology unit

within CMPE• Evolving structure in accordance with function and

strategy at CMPE• Increased capacity for M&E within CMPE and

implementing partners

Weaknesses• Shortage of qualified human resources for

SME at all levels• Lack of clear strategies for working

effectively with the private sector on malaria reporting

• Lack of data on individual malaria patients• Lack of computers at health facilities• Lack of reliable estimates of mobile and

migrant populations• Inadequate malaria surveillance and

information systems that fail to capture data from outside the public health sector

• Lack of confidence to take actions at local level

Opportunities• Strong government support to CMPE• Government's commitment to Public Administration

Reform in order to ensure sustainability of staff motivation and performance

• Increasing participation of other line ministries and NGO partners in surveillance and M&E activities

• GF Grants that focus on M&E Plans and PFs• More partners interested in collaborating on SME• Increasing decentralisation and deconcentration

Threats• Low motivation of health staff (incl. for SME) • Conflicting priorities particularly at provincial level

with neglect of SME• Difficulties in harmonising SME strategies with

other partners • Erratic supply of electricity making it difficult to use

computers, etc.• Potential reduced funding from GF for HR may

affect SME /Epidem. focal persons

Strengthening of relevant SME areas

• The aim of the national malaria program during 2016-20 phase will be to stop the malaria epidemic in the 6 southern provinces and move progressively towards malaria elimination in the northern provinces by scaling up surveillance.

• Once transmission in the south is brought under control the southern provinces will follow the north in moving into pre-elimination.

• Hence one major set of activities during 2016-20 will be the design and implementation of a surveillance and M&E system that will be able to rapidly detect, investigate and respond first to outbreaks in 6 provinces in the south and individual instances of local transmission in the north.

• Necessary domestic and external financial resources will be mobilised for achieving this aim keeping financial sustainability in mind.

Plan to strengthen the existing system for malaria elimination

• CMPE will work with WHO and other partners in the country to develop / update relevant guidelines including SOPs for Passive Case Detection, Active Case Detection, Foci identification and investigation and response, QA Diagnosis, Data management and reporting, Supervision, etc.

• Some of these areas of work are described in the following slides.

PCD & ACD proposed in Lao PDRPCD ACD

Definition: Detection of malaria cases among patients who on their own initiative visit a health post/facility for treatment, usually for febrile disease.

Definition: The detection by health staff of malaria infections at community and household level in high risk population groups. Active case detection can be conducted as fever screening followed by parasitological examination of all febrile patients or as parasitological examination of the target population without prior fever screening.

Purpose:The purpose is to enable measurement of incidence of malaria and define its person, place and time distribution in order to ensure more effective control. “You cannot control what you cannot measure”. It should be ensured that the collection of information is done in a timely, accurate and complete manner at every level in the system.

Purpose:ACD fills the gaps in the information from PCD with the purpose of ensuring that reservoirs of parasites are detected and treated early to interrupt transmission. The focus is on high-risk population groups.

Essential data elements to be collected for each casePCD ACD

• Date• No. of patient• Patient’s name, Age• Sex and Pregnant• Occupation• Address (place of residence)(suggested:

this province, another province and foreigner)

• History of travel• Whether referred from another place• Patient type (e.g. resident, migrant,

etc.)• Probable malaria (based on symptoms)• Type of blood test()• Result of blood test (Negative, Parasite

Species)• Treatment given ( ACT and other drugs)• Referral to hospital• Death from malaria.

• Date• No. of patient• Patient’s name, Age• Sex and Pregnant• Occupation• Address (place of residence)(suggested:

this province, another province and foreigner)

• History of travel (esp. in the last 2 weeks to forest)

• Patient type (e.g. resident, migrant, etc)• Symptoms and date of onset• Temperature (if measured)• RDT blood test• ? G6PD RDT• If slide/filter paper blot also collected• Result of blood test ( Negative, Parasite

Species)• Treatment with ACT

Data Flow(PCD)

PR/DCDC

Ministry of Health

18 PAMS

CMPE

143 District Anti Malaria Nuclei (DAMNs)

850 Health Centers

18 Provincial Hospitals / Military Hospital/Police

Hospital

148 District Hospitals(monthly by 143 DHs in malaria

areas )

2000 Villages in malaria areas (Zone 2 & 3)

5 central Hospitals (Setthathiath, MahosothMilitary HospitalPolice HospitalFriendship Hospital)

PPM Network(total 347)

Private Companies

Data Flow(ACD)

PR/DCDC

Ministry of Health

18 PAMS

CMPE

143 District Anti Malaria Nuclei (DAMNs)

850 Health Centers

High risk area/population group surveyed

Responsibilities for recording and transmission(PCD)

Data flow Responsible for recording

Responsible for transmission

Responsible for decision making

Village VHV/VMW HC staff (collect during monthly meetings)

Health center Chief (# of RDTs/ACTs for replenishment)

Health center Chief/Nurse Chief of HC HC Chief (planning services), Chief of DAM (supplies, response to outbreaks)

District Antimalaria Nucleus

Epidemiologist of DAMS


Chief of DAM (supplies, response to outbreaks, HR deployment, etc.)

Hospital (district/province)

Laboratory technician


Chief of PAM (supplies, response to outbreaks, HR deployment, etc.)

Provincial Antimalaria Station

Epidemiologist of PAMS



Responsibilities for recording and transmission(ACD)

Data flow Responsible for recording

Responsible for transmission

Responsible for decision making

Health center HC team with VHVs (if available) in high risk area

Chief of HC HC Chief (planning additional services), Chief of DAM (supplies, response to outbreaks)

District Antimalaria Nucleus



Chief of DAM (supplies, response to outbreaks, HR deployment, etc.)

Hospital (district/province)




Provincial Antimalaria Station




Recording of data on blood examination

PCD:• Type of test: Microscopy or RDT or PCR• Result of blood examination:

Negative or Parasite species (Pf, Pv and Mixed)ACD:• Type of test: RDT and Microscopy or PCR• Result of blood examination:RDT: Negative or Parasite species (Pf, Pv and Mixed)- For positive cases, DOT with antimalarials.

Microscopy/PCR: Negative or Parasite species (Pf, Pv and Mixed). For positive cases, the HC staff will have to return to administer full course of antimalarial treatment

Use of data in the control phase

PCD:

1. At the same level to identify disease trends and plan effective control and prevention interventions.

2. At the higher level to manage logistics for routine services and also potential outbreaks and institute prevention and control measures.

ACD:

3. At the same level to identify population groups at special risk and provide effective control and prevention interventions to these groups in order to reduce transmission.

4. At the higher level to plan and implement additional investigation, control and prevention measures to limit the spread of the disease .

Case investigation for elimination phase in the north

What is it?• Every case in a low incidence area is reported and

investigated immediately (and also included in the weekly/monthly reporting system).

• Cases are graphed daily or weekly to identify trends that require attention and are mapped by village to identify clusters of cases.

The purpose of case investigation:• The purpose is to identify the persons with malaria, the

extent of malaria around the case (who else is affected) and probable sources of infection (local or imported from another province/country).

• To identify and institute measures to interrupt further transmission.

Case Investigation form and details• The form: see word file

• Who will fill in the form: • Malaria health staff (either from health center or district level)

and in future surveillance teams at district level.

• What is the timeline for completion : • Within a week of case being reported from a previously low

incidence area it will be investigated

• How will it be transmitted:• Immediately after investigation, the information will be conveyed

to the next higher level by telephone and physically submitted within 48 hours.

• Who will check it:• Malaria staff at the next higher level

Classification and use of Data• Who will classify the case:• Same level based on clear criteria and information

collected through the investigation.• Who will use the data for what:1. At the same level to classify case, identify potential

focus and institute immediate response measures.2. At the higher level to plan more detailed

investigations if necessary, confirm classification of the cases and institute necessary response measures.

Use of different laboratory methods in the elimination provinces

Level RDT Microscopy

Village √

Health center √ √ (if microscope and microscopist available)

District √ √

Province √ √

1. We will refine SOPs after returning to Laos2. Slides will be collected from the field and examined at the nearest

laboratory.3. Upon microscopy confirmation, the appropriate treatment by DOT will

be provided to those found to be positive.4. Negative RDT results will be double-checked by microscopy on a sample

basis5. Discrepancies will be handled by reference to clearly developed SOPs

and institution of quality assurance measures

Microscopy

Types of Foci

Definition Operaional criteria Case detection measures VC measures

An area with conditions for transmission, where transmission has ceased and currently no cases are

Transmission in the past, no cases for 2 years, under adequate surveillance

PCD, with supervision 4 times per year (with ABER at least 3%)

Promotion of mosquito nets .

One or more cases but no local transmission (relapse or induced or imported)

Transmission in the past, no indigenous cases for 2 years or more, under adequate surveillance.


Distribution of one round of LLINs or 1 round of focal IRS

Introduced and indegenous cases and active transmission in the last 2 years or more

Transmission on going with introduced and indigenous cases for 2 years or more, under adequate surveillance.

PCD and ACD with supervision 4 times per year (with ABER at least 3%)

Focal IRS with one round of LLIN distribution followed by continuous distribution of LLINs for new arrivals, MMPs, pregnant mothers and replacements. Cluster of imported cases (

from outside country or outside province) no evidence of local transmission

No local transmission but a number of imported cases reported recently, under adequate surveillance.


Not required

Type of focus

Potential foci

Active foci

Pseudo focus

Cleared up focus

Assessment of human resources needsLevels Positions

requiredPositions in place

Gaps to be filled Total gap for Lao PDR

Provincial level:• Coordinator of PAM• Epidemiologist• Lab technician• IT • Entomologist• logistic

• 1• 3• 2• 1• 2• 2

• 0• 2• 1• 0• 0• 1

• 1• 1• 1• 1• 2• 1

District level:• Malaria management• Epidemiologist• Lab Technician• Logistics Manager

• 1• 2• 2• 1

• 0• 1• 1• 0

• 1• 1• 1• 1

To be estimated separately for elimination and control areas after further analysis at CMPE.

Health center level:• Lab Technician• Monitoring Officer

• 1• 1

• 0• 0

• 1• 1

Village level:• VHV/VHW • 2 • 1 • 1

Need for new people: - Yes, for e.g. Coordinator PAM, IT, Logistics, etc

Challenges to recruit these positions:• Government policies and procedures• Limited availability of skilled HR at provincial and district

level• Competition from private sector and NGOs for skilled HRHow to recruit:1. Approach concerned authorities within Government to

allow MOH for special recruitment for Saravane province

2. Undertake temporary recruitment of contract staff with donor support- clear handover arrangements to GOV staff to be written in to the MOU with donor.

How will training and supervision be done

1. Training needs analysis will be undertaken2. Curricular committee to be set up3. Curricular committee to design/redesign training curricula, training plans

and training materials4. Training of trainers will be undertaken for CMPE and provincial trainers with

WHO and other partner support5. Training courses and on the job training will be conducted in a cascade

manner [ including at community level}6. Supervision guidelines and checklists will be updated by CMPE staff with

provincial representatives and implementing partners7. Supervision guidelines and checklists will be included into the ongoing

training courses8. Quarterly Supervision plans will be developed at all levels and implemented.9. Supervision visit reports will be followed up to track changes in programme

implementation and correlated with other data at monthly and quarterly review meetings.

Need for HR once elimination has been achieved • Many of the staff will be needed when the

province enters into elimination phase since surveillance will need to be further strengthened at that stage.

• A fresh HR needs analysis will be undertaken at that stage and staff redeployed or assigned revised tasks as per requirement.

• Once elimination is achieved, malaria specific staff will be redeployed for other vector borne and parasitic disease control and also to prevent re-introduction.

Revised essential job descriptions for surveillance workers

Detailed TORs will be developed for Surveillance Staff at different levels incorporating the following key tasks.

– Verification, quality review and compilation of data collected through passive case detection from public health facilities, PPM outlets and communities

– Organising and implementing Active Case Detection in high risk areas (hotspots) and population groups (hot pops)

– Monitoring of ecological and social determinants incl MMPs and development projects

– Organising Rapid response during outbreaks and following ACD – Case and foci investigations in elimination areas– Coordinating with other malaria staff in use of data for decision

making– Report and provide feedback at all levels

Proposed Indicators in Selected Province in Malaria Elimination Phase

# Selected Indicator name

Definition (numerator/denominator)

2014 data Remarks

1.

ABER N= total test done during the year( RDT+Micro+Both)D= Total Pop ( at risk) of the province (mid-year estimate)

0.13 Will decline over time in elimination areas

2.

% expected monthly reports received from health facilities and laboratories

N= Total # of expected monthly reports received from health facilities and laboratories D= Total # of health facilities and Laboratories

96.3% Emphasis will be on receipt of timely and complete reports

Name of selected Province: HUAPHAN PROVINCETotal population: 35872Population at Risk of Malaria: 35872Annual Parasite Incidence (2014): 0.02

Proposed Indicators in Selected Province in Malaria Elimination Phase (contd.)

# Selected Indicator name

Definition (numerator/denominator)

2014 data Remarks

3. % of confirmed cases fully investigated

N= Total # of fully investigated confirmed casesD= Total # of confirmed cases

0% To be monitored only in the elimination provinces. Full investigation includes case investigation form, focus investigation form and active case detection.

4. % of foci fully investigated and registered (on register, with maps of each focus)

N= Total # of foci fully investigated and registeredD= Total # of foci identified and reported

0% To be monitored only in the elimination provinces.Full investigation of a focus includes focus investigation form, entomological investigation form and active case detection.

Upgrade Malaria Information System o The MOH is introducing a national health information system (DHIS2) o This will have a module for malaria data o In the meantime CMPE will recruit a short-term technical advisor to upgrade

the current MIS taking into account the revisions to the M&E plan and to develop an integrated database covering all aspects of the national malaria control/elimination effort, both technical (e.g. drug resistance, bednets, entomology and insecticide resistance etc.) and administrative (e.g. HR [including volunteers], PSM, infrastructure etc.).

o Mapping will be incorporated to allow detailed spatial analysis of all relevant aspects of the program and to thereby improve targeting.

o The system will be designed to produce a quarterly bulletin that summarizes the epidemiological situation and highlights important trends.

o Data collection forms will be simplified and data collection, analysis and interpretation will be strengthened and supported through on-the-job training and supportive supervision.

o The program will ensure adequate supply of reporting forms (or access to computers/printers/copiers for printing).

Electronic (IT) based data management

Introduce 'mHealth' for surveillance. omHealth will be rolled-out to enable real time reporting

by health staff and volunteers. Staff and volunteers will be provided with smart phones as required.

o This will be integrated into the mHealth initiative for supply chain management.

o Elimination specific data entry formats will be introduced in areas targeted for elimination.

o Data collection will be expanded to include results of case investigations, DOT and weekly follow-up to ensure clinical cure.

Electronic (IT) based data management (contd.)

Strengthen routine supervision and programmatic M&E

Conduct routine programmatic monitoring and supportive supervision at all levels.

Detailed SOPs, updated checklists and discussion topics will be provided to supervisors to ensure that all activities are thoroughly assessed at every level. Emphasis will be placed on problem solving.

Mechanisms will be developed to ensure that feedback is provided to supervisees at all levels and to ensure that follow-up occurs, and continues to occur until issues are resolved.

Field monitoring and Supportive Supervision

Improving the organization of supervisory visits

Intervention: Malaria diagnosis by microscopy.Problems How to manage (solutions)

Diagnosis Improve skills in identifying species

Slide preparation Train in correct slide preparation including cleaning of slide before preparation and preservation.

Poor staining Coach on following proper staining procedures

Poor maintenance of microscopes Demonstrate how to clean and maintain microscope before and after.

Outline of an improved organization of supervisory visits for the intervention considered

Where What and who to supervise

Supervisory methods

When:Frequency

Who will conduct sup. visits

Other interventions that could be supervised at the same time

Community Not applicable

Health center with microscopy

Microscopy service of HC lab technician

On the job supervision by hospital lab technician

Once per month

District hospital lab technician

Check stock of slide, reagents, RDT and ACT.

District level

Microscopy service of district lab technician

On the job supervision by hospital lab technician

Once per month

Province hospital lab technician


Provincial level

Microscopy service of province lab technician

On the job supervision by central lab technician

Once in three months

CMPE lab technician


Central Level

Internal QA of microscopy

External QA Once in two years

WHO hired expert

National slide bank

Communication of resultsOutcome 1: Enlist support of provincial governor for launching LLIN mass distribution campaigns

Message Audience Media Timing Resources

LLINs if used regularly and correctly can bring down malaria significantly in our province.

Provincial governor

PowerPoint presentation to the Governor with charts showing malaria declines in provinces with good LLIN coverage

One-to-one meeting arranged at least 2 months prior to campaign launch date

Money- not requiredHR- need ministry senior officials to support and attend the meeting

Outcome 2: Enlist support of director of province health department to improve quality of malaria microscopy

Message Audience Media Timing Resources

Malaria microscopy is the gold standard for malaria diagnosis for malaria elimination and this is currently poor in province X

Health department of province X

Supervision report and slide cross check result for province X

Debriefing at the end of supervision visit

Participation of province health director, chief of provincial malaria station and microscopists.

Communication of results (contd.)

Baseline SME System assessment has been commissioned by ERAR and carried out by MC in collaboration with DCDC and CMPE.

The baseline assessment findings will be disseminated in a workshop in early Nov 2015 and an action plan to address weaknesses will be finalized.

This action plan will be nested within the National M&E Plan for 2016-20 to be finalized by Dec. 2015.

Mid-term SME System assessment will be incorporated into the National Malaria Programme Review to be carried out in 2017.

An end of term SME System assessment will be incorporated into the National Malaria Programme Review to be carried out in 2020.

Evaluation of SME System performance

Reporting Type of Reports

Contents of reports

Recipients/audience

Comments

Immediate • Malaria cases and deaths

• Malaria commodities

• Case and focus investigations

Surveillance and response staffLogistics staff

Real-time reporting will be introduced in a phased manner in order to provide prompt response.

Monthly • Malaria cases and deaths

• Malaria commodities

• Summary of case and focus investigations

Programme, surveillance and response staffLogistics staff

Standardised reports will be generated and disseminated both upwards and downwards in the system.

Reporting (contd.)

Type of Reports

Contents of reports

Recipients/audience

Comments

Semi-annual

1. Performance against selected key indicators

2. Overall performance, challenges and plans for following periods.

Ministry of HealthDonorsImplementers

Semi-annual malaria bulletins and standardised reports will be generated and disseminated both upwards and downwards in the system in addition to being submitted to donors (for e.g. GF, ADB) and MOH.

Annual As above As above As above

Ad-hoc/ special

For e.g. outbreak reports, focus response reports, special reports to Government, UN agencies, etc.

Ministry of Health and stakeholders making special requests

Reports will be prepared and submitted as required from time to time.

Establish a National Independent Malaria Elimination Monitoring Committee

An external Quality Assurance Committee will be constituted comprising of the following members and tasked with providing external quality assurance for implementation of the NSP.– National level epidemiologists– Former malaria programme managers– Retired WHO experts– Others nominated by government and development

partners

Updating legislation, as part of enabling environment

CMPE will advocate and coordinate efforts for enacting and updating facilitative legislations:– Mandatory notification initially in elimination provinces

and later extended to entire country ; – Compulsory parasite based diagnosis; – Private sector participation; – Appropriate treatment and follow up of confirmed

cases;– Access to quality anti malarial medicines(ban on

monotherapy and counterfeit/substandard antimalarials)

Involvement of private sector Expansion and improvement of the existing PPM initiative. • The network of licensed private sector providers will be expanded to cover

all six southern provinces. • Abetter enforcement by FDD on the accreditation scheme (used for

continuing issuance of licenses) under the GPP (good pharmaceutical practice).

• SOPs for PPM have already been designed, but need to be revised and implemented better.

• PPM facilities will be provided with free RDTs and ACTs and in return will have to ensure all suspected cases are confirmed, notified, investigated and appropriately managed and provide reports on cases diagnosed and treated to the malaria programme.

• Training and support for referrals will be prioritised. Engagement of the corporate sector • The program will engage the corporate sector and encourage corporate

support/sponsorship for malaria control/elimination efforts (including World Malaria Day activities).

Khop jai lai lai!Thank you very much!

Strengthening SME system for Lao PDR National Malaria Programme (2016-2020) By Dr. Bouasy, Dr. Viengxay and Dr. Odai CMPE, Lao PDR With support from Dr.

Documents

plasmodium falciparum

species of malaria

malaria epidemic

forms of malaria

malaria eliminationpcd

malaria program phases

entire country

existing system